Individual
DR. KELLY M. HUMPHERYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 WYANDOTTE, RAMONA, OK 74061-1337
(918) 536-2104
(918) 536-2203
Mailing address
P.O. BOX 420, 400 WYANDOTTE, RAMONA, OK 74061-1337
(918) 536-2104
(918) 536-2203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
26599
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163634001
—
AR
05
—
200207550A
—
OK
05
—
206226201
—
MO
01
—
5N728
AR BLUE SHIELD #
AR
Enumeration date
10/20/2006
Last updated
10/18/2011
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